It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board

  • PSA ticked up from undetectable

  • Post New Thread   Reply Reply
    Thread Tools Search this Thread
    Old 06-08-2022, 06:29 PM   #1
    boort
    Newbie
    (male)
     
    boort's Avatar
     
    Join Date: Jun 2022
    Location: British Columbia
    Posts: 3
    boort HB User
    PSA ticked up from undetectable

    I had RP in 2013. PSA hovered about went to .7.

    I had radiation in 2019 and PSA went undetectable until today where I got 0.011

    What is the best/worst interpretation of this result?

     
    Reply With Quote
    Sponsors Lightbulb
       
    Old 06-08-2022, 08:21 PM   #2
    HighlanderCFH
    Senior Member
    (male)
     
    HighlanderCFH's Avatar
     
    Join Date: Jul 2014
    Location: Highland
    Posts: 137
    HighlanderCFH has disabled reputation
    Re: PSA ticked up from undetectable

    Hi, I'm not good with math, but I believe this new number is still undetectable as far as the standard (non-ultra sensitive) PSA test goes.

    So I would not be worried at all.

     
    Reply With Quote
    The Following User Says Thank You to HighlanderCFH For This Useful Post:
    boort (06-10-2022)
    Old 06-09-2022, 10:24 AM   #3
    IADT3since2000
    Senior Veteran
    (male)
     
    Join Date: Nov 2007
    Location: Fountain Valley, CA, USA
    Posts: 3,172
    IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
    Re: PSA ticked up from undetectable

    Hi boort and welcome to the Board!

    The bottom line is that I agre with Highlander CFH.

    The worst interpretation is that the cancer you once had is recurring and causing an increase in PSA. That said, recurrences vary widely in threat level - some so mild that no treatment is needed, just continued monitoring, while at the other extreme some are life-threatening. Both the time from your surgery to your radiation and the time from your radiation until that detectable PSA are fairly long, suggesting that a recurrence would be toward the mild end of the spectrum, if indeed there is a recurrence at all.

    Even if there is a recurrence, modern imaging and other modern tools will be able to locate it and assess its seriousness, when the time comes - at this point it is too early for imaging to spot a possible metastatic location(s), but should there be an upward trend, imaging will be able to spot the source at a very early point. Spot surgery and/or spot radiation should be able to eliminate the source, likely constituting a cure, or other approaches, such as medication, may either cure the cancer or set it back so that it is a mild issue.

    The best case - fairly likely - is that you are just experiencing a "detectable" PSA (barely detectable using an extremely sensitive version of an ultrasensitive PSA test) because of a very minor variation in your PSA level that has strayed over the line of detectable versus undetectable. It would help to have recent PSA results, but I'm thinking that your prior results have been < ("less than") 0.010. Now the real result, if a reliable test with four decimal places were available, could have been 0.0104, with rounding to <0.010. But if that small variation in PSA - due possibly to seasonal, day-to-day, time of day, even extremely minor variations in the test kit or analytic protocol/environment - caused the PSA to "rise" to 0.0105, it would round to 0.011. Indeed, several leading medical oncologists specializing in just prostate cancer whom I follow believe that results below 0.01 are not clinically useful, at least they believed that up to several years ago.

    My hunch is that you are still in excellent shape. If this is bothering you, you could ask for another test in a shorter-than-usual time, say in a month, two or three.

    Where are you in British Columbia? Vancouver is one of the world's centers of prostate cancer expertise. Researchers there have done a lot to advance the field over the years. Many doctors do not use an ultrasensitive PSA test that gives results to the third decimal point. If you are being treated in Vancouver, it may be that your doctors are using that extremely sensitive test partly for research purposes with an objective of finding out whether such extremely small variations in PSA are useful for clinical assessment and decision making.

    Good luck!

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - --
    22 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

    Last edited by IADT3since2000; 06-09-2022 at 10:26 AM. Reason: Added agreement with Highlander.

     
    Reply With Quote
    Old 06-09-2022, 11:09 AM   #4
    DjinTonic
    Senior Veteran
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 574
    DjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB User
    Re: PSA ticked up from undetectable

    Quote:
    Originally Posted by boort View Post
    I had RP in 2013. PSA hovered about went to .7.

    I had radiation in 2019 and PSA went undetectable until today where I got 0.011

    What is the best/worst interpretation of this result?
    It is very unlikely that your cancer is returning based on just this PSA value. First, what was the "undetectable" value you had until today? Was it also Labcorp's 3-decimal test, in which case it was either <0.014 or <0.006, depending on when the test was done. A value of 0.011 can be a very small increase or decrease, depending on which value you had.

    If your past undetectable was a less sensitive test, e.g. <0.02 or <0.05, then your new value is well below those limits of detection.

    With the 3-decimal test, you have to expect some normal fluctuation in your body's production of PSA. Also, at PSA values around 0.010, it has been shown that the assay that Labcorp uses can vary 0.002 on the very same sample when that sample is retested! The combination of internal factors (your body) and external factors (sample prep., equipment calibration, intrinsic test method, etc.) means some small fluctuation is typical.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.023 (4 yr. 6 mo.)

     
    Reply With Quote
    Old 06-10-2022, 07:15 AM   #5
    boort
    Newbie
    (male)
     
    boort's Avatar
     
    Join Date: Jun 2022
    Location: British Columbia
    Posts: 3
    boort HB User
    Re: PSA ticked up from undetectable

    Thanks for this.
    I'm in Victoria, B.C -- not far from Vancouver -- and and we have an excellent and well-funded cancer clinic here. I have had a good experience with them. Great people. There is also an active volunteer community of cancer survivors who help with rides to treatment and so on.

    Since the radiation my PSA has been <0.008 which is our lab's lowest measure. So this recent measure is an increase of at least 0.003 but -- hypochondriac shrieking -- "it could be more".

    Thanks again for your response.

     
    Reply With Quote
    The following user gives a hug of support to boort:
    IADT3since2000 (06-11-2022)
    Old 06-10-2022, 07:19 AM   #6
    boort
    Newbie
    (male)
     
    boort's Avatar
     
    Join Date: Jun 2022
    Location: British Columbia
    Posts: 3
    boort HB User
    Re: PSA ticked up from undetectable

    I don't know the type of test, but the lowest possible value I've seen is " <0.008 ug/L"

     
    Reply With Quote
    Old 06-21-2022, 08:26 AM   #7
    Insanus
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 228
    Insanus HB UserInsanus HB UserInsanus HB UserInsanus HB UserInsanus HB UserInsanus HB User
    Re: PSA ticked up from undetectable

    Quote:
    Originally Posted by boort View Post
    I had RP in 2013. PSA hovered about went to .7.

    I had radiation in 2019 and PSA went undetectable until today where I got 0.011

    What is the best/worst interpretation of this result?
    Unless your next test is undetectable PSA, I believe you are on your way to official BCR and you might have another chance for a cure. Id be thinking seriously who you are going to use for treatment.

     
    Reply With Quote
    The Following User Says Thank You to Insanus For This Useful Post:
    boort (06-22-2022)
    Old 06-21-2022, 04:11 PM   #8
    IADT3since2000
    Senior Veteran
    (male)
     
    Join Date: Nov 2007
    Location: Fountain Valley, CA, USA
    Posts: 3,172
    IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
    Re: PSA ticked up from undetectable

    Hi again boort. You wrote:

    Quote:
    Originally Posted by boort View Post
    I don't know the type of test, but the lowest possible value I've seen is " <0.008 ug/L"
    I'm always concerned when a post prostatectomy patient joyfully says "I'm undetectable" and the PSA result is <0.1. That's risky. Usually I don't post that concern as I don't want to rain on their parade, however I always strongly favor use of ultrasensitive tests, ideally sensitive down to <0.01, post-op.

    But, the experts I follow - mainly medical oncologists with large practices dedicated just to prostate cancer, who pioneered use of ultrasensitive tests regularly more than two decades ago and who did a lot of them - did not consider variations below the second decimal point to be meaningful. You have what is a clinically meaningful undetectable PSA at this point. Congratulations!

    It can be hard for us to relax, but I think you are entitled to do just that!

    Jim

     
    Reply With Quote
    The Following User Says Thank You to IADT3since2000 For This Useful Post:
    boort (06-22-2022)
    Reply Reply

    Related Topics
    Thread Thread Starter Board Replies Last Post
    The Role of Antibiotics in Assessing Causes of PSA Elevation IADT3since2000 Cancer: Prostate 12 03-09-2022 12:16 PM
    The Fine Print for Trial Score Keeping: Overall Survival, Met. Free Survival, and PSA IADT3since2000 Cancer: Prostate 11 07-07-2021 06:05 AM
    PSA returns 3 years after surgery mtgun Cancer: Prostate 30 03-01-2020 01:48 PM
    Benign Prostate Enlargement (BPH), PSA and Prostate Cancer: When to Biopsy? IADT3since2000 Cancer: Prostate 12 01-07-2020 09:51 AM
    48 yrs old, 8.6 PSA, 8.4 percent free PSA flyted Cancer: Prostate 2 08-04-2018 09:11 PM




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 04:50 PM.





    © 2022 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!